Teleradiology works by transferring a study and its clinical context to a radiologist at another location, then returning the interpretation to the facility. A complete service must also handle incomplete cases, urgent communication and questions after delivery. The scan is only one part of the information that needs to move.
This guide follows the case in the order your staff encounters it. For the underlying service model, read what teleradiology is.
1. Prepare the examination and clinical context
Your facility acquires the images and supplies the order, examination details and relevant clinical history. Available prior studies and reports may be important to the interpretation. Establish who supplies them and how the reading team requests missing information.
Before sending live cases, test patient and accession identifiers. The same patient may have multiple examinations, and a transferred image set must remain associated with the correct order. Ask what happens when identifiers do not match or a study arrives in more than one transfer.
2. Transfer the case and confirm receipt
Images are commonly exchanged using DICOM. Orders, status information and reports may use other interfaces, including HL7, depending on the systems and integration. The DICOM standard supports imaging exchange; it is not a promise that any two installations will connect without configuration.
Agree which system confirms receipt and how your team identifies failed or incomplete transfers. A study leaving the scanner is not necessarily the same event as a complete case becoming available to a radiologist.
3. Put the case in the right reading queue
The service needs to assign work according to its agreed coverage, examination type, priority and reader availability. Ask how your STAT designation is transmitted and how the team handles a case outside the contracted scope.
At Natoe, orchestration connects intake and assignment with reporting and delivery. Your staff can follow a case and raise a question in the shared workflow. The operating agreement should still identify the service hours and responsibilities for exceptions.
4. Review images and supporting information
The radiologist examines the study and relevant context using the approved reading environment. If required information or image quality is insufficient, the workflow needs a way to request help from the facility rather than silently moving the case forward.
On applicable studies, Natoe uses FDA-cleared AI algorithms to support finding detection for the radiologist’s review. This is a specific capability, not a claim that every study or every reporting function is covered by the same algorithm. See the AI-supported reading workflow.
5. Prepare, review and sign the report
Natoe DXR turns the radiologist’s dictated findings into a structured draft. The radiologist reviews that draft, makes necessary changes and signs the final interpretation. Automated report QA can flag issues for review, including inconsistencies between findings and the impression.
The useful demonstration is not just text appearing on a screen. Ask to see what was dictated, how the draft was structured, what a quality flag refers to and how the radiologist corrects it. Do not treat automated checking as a guarantee that every error will be detected.
6. Deliver the report and handle urgent communication
The signed report returns through the agreed integration or delivery route. Test that it appears against the correct examination, that its final status is clear and that any receiving-system acknowledgment is captured where required.
Clinical escalation is separate from routine report transmission. Agree who contacts the responsible clinician about critical findings, how receipt is acknowledged and the fallback when the first contact is unavailable. Do not assume an interface notification alone completes that process.
A routine daytime reading agreement should not be interpreted as an after-hours service. Establish where urgent work and clinical questions go outside the contracted window before launch.
7. Keep questions and addendums attached to the study
Delivery does not end every case. A facility may need to supply additional history, ask about an examination detail or request review of a report. Distinguish a request awaiting review from a completed amendment.
In Natoe’s workflow, report edits and addendum requests can appear in the Under Review queue associated with the original study. The radiologist assesses the request. Ask to see the request, response and updated report in one walkthrough, including how the update reaches your receiving system.
What to verify during onboarding
| Test | Evidence your team should see |
|---|---|
| A routine case | Correct order and images received; assignment visible; signed report returned to the correct examination. |
| A STAT case | Priority reaches the reading queue; the agreed clock and escalation route are understood. |
| Missing information | The responsible team is notified and can supply context without creating a disconnected case. |
| A prior examination | The reader can locate the relevant prior images/report and distinguish them from the current study. |
| An addendum | The request reaches the radiologist; the approved update is identifiable in both systems. |
| A connection problem | Staff know the escalation contact and the agreed continuity procedure. |
Use de-identified test data and record acceptance of the actual configuration. The schedule depends on contracting, credentialing, interface work, testing and training. Avoid treating a generic onboarding estimate as a guaranteed launch date.
Measure the service where delays occur
Agree the timestamps you will review: transfer, complete receipt, availability for reading, signature and receipt by your system. This makes it possible to distinguish a transmission problem from a reading delay or failed report delivery.
For turnaround, measure performance against the agreed window and inspect overdue cases as well as averages. For follow-up, check how long questions remain unresolved and whether the final answer returns to the right staff member.
Natoe’s confirmed commitments are STAT reports within one hour and routine reports the same day, within the agreed examination scope and reading hours. Your proposal should define how these apply to your workflow. Review reading services or discuss your facility’s requirements.
Common implementation questions
Do we need to replace our PACS? That depends on your current configuration and the proposed connection. Ask both technical teams to validate compatibility and all required interfaces before committing to a change.
Who reviews the AI-generated draft? In Natoe’s service, its radiologist reviews and signs the report. The facility is not being asked to employ a reporting team to operate DXR.
Who owns privacy and security? Responsibilities follow the actual service arrangement and applicable requirements. HHS’s Security Rule summary describes safeguards for electronic protected health information. Review your data flow and Natoe’s security information alongside the agreement.
How do we compare providers? Give them the same study mix, hours, volume and test scenarios. Our US teleradiology companies guide provides a proposal checklist.
